Magellan Healthcare is working with Idaho to truly transform how behavioral health and substance use disorder services are delivered in the state. We’re looking for all sorts of provider types to join us in this effort, from outpatient therapists and hospitals to community service organizations.
How to join our network
It’s easy! Submit a Letter of Intent. If you’re an
individual practitioner, a group or a facility, this
is where you’ll start.
Are you a youth-serving agency?
If so, learn about Idaho Wraparound Intensive Services (IWInS) and High-Fidelity Wraparound (HFW).
Credentialing and contracting
Credentialing
Practitioners must meet and maintain a minimum set of credentials to be able to provide services to IBHP members as a Magellan network provider. You must successfully complete the credentialing review process and have your credentials re-reviewed every 36 months through the recredentialing process.
Magellan participates in CAQH® for online data collection to help providers reduce the amount of administration and paperwork involved in credentialing.
For more information:
- Refer to the handbook documents posted on the For Providers / Handbooks page for Magellan’s credentialing policies and your responsibilities.
- Watch our brief credentialing videos for individual practitioners or for organizational providers.
- Review this required documents checklist (PDF).
- Explore the training recordings on the For Providers / Events and Training page.
Contracting
To be eligible for referrals and reimbursement for covered services rendered to IBHP members, each provider – whether an organization, individual practitioner, or group practice – must sign a Magellan Network Provider Agreement agreeing to comply with Magellan’s policies, procedures, and guidelines.
For more information:
- Refer to the handbook documents posted on the For Providers / Handbooks page for Magellan’s contracting policies and your responsibilities.
- Explore the training recordings on the For Providers / Events and Training page.
- Review a brief video on how to complete the Medicaid Disclosure Form.
For questions about credentialing or contracting, email our provider services team at IdahoProvider@MagellanHealth.com.
High-level requirements for IBHP providers
Below are basic requirements providers must meet in order to participate in Magellan’s network:
- Have no exclusions from participation in federal healthcare programs under either Section 1128 or Section 1128A of the Social Security Act and 42 CFR § 438.214(d) and not be on the Idaho Medicaid Exclusion list.
- Obtain a unique national provider identifier (NPI), unless you are a paraprofessional.
- Operate within your license, certification, and scope of practice.
- Obtain and maintain all applicable insurance coverage.
- Provide all requested information during credentialing and contracting and update or confirm accurate data each quarter.
- Share, as appropriate, member health records in accordance with professional standards and applicable CFRs.
- Meet the substance use disorder (SUD) qualified professional requirements outlined in IDAPA 16.07.17.200-415 and the Idaho Medicaid State Plan, if you are an SUD treatment provider.
- Meet provider qualifications specified in IDAPA and the Idaho Medicaid State Plan, if you are a mental health provider.
- Ensure you and all staff, employees and subcontractors of your organization have not had your/their professional certification or license suspended or revoked based on disciplinary action by the Idaho Board of Alcohol/Drug Counselor Certification, or the Idaho Division of Occupational and Professional Licensing due to any licensing violation.
- Pass the appropriate level of criminal history and background check clearance for your/your staff member’s/subcontractor’s provider type pursuant to IDAPA 16.05.06, or receive the appropriate DBH/Medicaid criminal history and background check waiver/variance if you have/the person has been granted a waiver/variance to clearance requirements by one (1) or both divisions.